Provider Demographics
NPI:1083767719
Name:KIEKHOEFER, GARY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:KIEKHOEFER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619 W POINT DOUGLAS RD S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4162
Mailing Address - Country:US
Mailing Address - Phone:651-458-0094
Mailing Address - Fax:
Practice Address - Street 1:8619 W POINT DOUGLAS RD S
Practice Address - Street 2:SUITE 110
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4162
Practice Address - Country:US
Practice Address - Phone:651-458-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2666111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician